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RULES 

t 

GOVERNING THE 

Transportation 

of THE 

Bodies of Deceased Persons 


Alabama 


ADOPTED BY THE STATE BOARD OF HEALTH 
APRIL 22, 1910 


MONTGOMERY, ALABAMA 
JUNE 15, 1910 





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RULES FOR THE TRANSPORTATION OF THE BODIES OF 

DECEASED PERSONS IN ALABAMA. 


PURSUANT TO AUTHORITY GRANTED BY SECTION 725 OF 
VOL. 1 OF THE CODE OF ALABAMA, THE STATE BOARD OF 
HEALTH HAS ADOPTED, AND HEREBY PROMULGATES, THE 
FOLLOWING RULES FOR REGULATING, AND UNDER CERTAIN 
CONDITIONS FORBIDDING, THE TRANSPORTATION OF THE 
BODIES OF DECEASED PERSONS INTO, THROUGH, OR FROM 
PLACE TO PLACE IN, THIS STATE. 


For the information of all parties concerned the following quotation 
from the law of the State regulating “Embalming” is made: 

“Any licensed physician may embalm bodies in case of death out¬ 
side of any incorporated municipality having a population of 500 inhab¬ 
itants, or in such municipality at any time when there is no licensed em- 
balmer in said municipality.” 


1. Bodies of persons who have recently died : 

RULE 1. 

The body of a person who dies of erysipelas, puerperal fever, pneu¬ 
monia, measles, cerebro-spinal meningitis, tuberculosis, typhoid fever, 
whooping cough, beri-beri, parotitis (mumps), or hydrophobia, shall in 
order to be entitled to transportation by a public carrier be prepared as 
follows: 

(a) —The body, including the hair, must be thoroughly bathed in 
one of the disinfecting solutions, the formulae for which are given below, 
and will hereafter be referred to as a disinfecting solutions”; 

(b) —All orifices shall be securely closed with unwashed or raw cot¬ 
ton, or with unwashed or raw wool; 

(c) —After the body has been shrouded and placed in a coffin not less 
than six (6) ounces of formaldehyde, or carbolic acid, shall be 
poured over a roll of absorbent cotton, or a sponge, of suitable size, or 
over an ordinary sheet, closely rolled, and placed in the coffin, the lid of 
which shall be quickly and firmly fastened down and not again removed; 

(d) —The coffin must be completely enveloped in not less than 
two thicknesses of dry cotton flannel, or of heavy sheeting, of such dimen¬ 
sions as to admit of being freely overlapped at the sides and ends of the 
coffin, and it shall be so overlapped and securely stitched in place; 

(e) —The coffin must then be placed in a zinc-, tin-, or copper-lined 
case, the lid of which is provided with a rubber or felt gasket, so that 
when fastened down the case will be rendered air-tight, and it must be 
fastened down and not again opened; 

(f) —In the absence of a case susceptible of being made air-tight the 
space betwixt the coffin and the case shall be compactly filled with dry 

D. OF Di: ; 

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saw-dust, excelsior, cotton, cotton-seed, sand, or pulverized charcoal, the 
material used being freely sprinkled, as laid in, with one of the disin¬ 
fecting solutions.” The lid of the case must then be firmly fastened 
down and not again removed; 

(g) —The case must not be carried into the room in which the person 
died, nor into any infected part of the house, but the coffin after having 
been prepared as above required shall be removed from the room, or house, 
before being placed in the case; 

(h) —The body of a person who dies of any of the diseases enumer¬ 
ated under this Rule (1), and which has been prepared as above required, 
shall be entitled to transportation by a public carrier at any time between 
the first day of April and the first day of November, provided that such 
body can reach its destination in thirty (30) hours, or less, from the time 
of death; at any other season the time shall be extended to forty-eight 
hours; 

(j) —A certificate must be filled out in triplicate (Form No. 1) 
the original and the two copies being denominated, respectively, the 
original certificate, the first copy, and the second copy . The original cer¬ 
tificate must be securely tacked to the lid of the case containing the cof¬ 
fin ; the first copy must be delivered to the agent of the public carrier at 
the initial point of shipment and must be by him permanently filed, and 
shall be subject to inspection at any time by the health authorities hav¬ 
ing jurisdiction at said point; the second copy, with a coupon attached 
thereto, shall be delivered to the baggage master, or expressman, of the 
public carrier at the initial point of shipment, and shall accompany the 
body to the terminal point of shipment, being transferred from baggage 
master to baggage master, or from expressman to expressman, when the 
body is transported over connecting lines, and shall be filed in the office 
of the public carrier at the terminal point of shipment, where it shall 
be subject to inspection by the health authorities having jurisdiction over 
the locality. 

The coupon attached to the second copy of the certificate shall be 
filled out by the baggage master, or expressman, in charge of the body 
when it reaches its terminal point and shall be detached and mailed to 
the signer of the certificate; 

(k) —Said certificate and the copies thereof may be signed by a li¬ 
censed physician, in case the body was prepared for shipment outside of 
a municipality having a population of 500 inhabitants, or less, or 
in any municipality without a licensed embalmer therein; or, said 
certificate and the copies thereof may be signed by an embalm- 
er holding a license issued under the authority of the State, provided that 
the person signing the certificate and the copies thereof shall have per¬ 
sonally superintended the preparation of the body; 

(l) —If, however, in addition to compliance with the above require¬ 
ments, the body of the deceased person has been embalmed by an em¬ 
balmer, licensed under the authority of the State, in accordance with a 
method accepted as complete and efficient by professional embalmers, and 
if a certificate to that effect, corresponding with Form No. 2, given 
below, be filled out in triplicate, the original and the first and second 
copies being applied and filed as required under specification (j), then, 
the limitations as to time and season prescribed under specification (h) 
shall not apply. 

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RULE 2. 

The body of a person who dies of diphtheria or membranous croup, 
scarlet fever, yellow fever, or small-pox shall, in order to be entitled to 
transportation by a public carrier, be prepared as follows: 

(a)—It shall be thoroughly bathed, including the hair, in one of the 
“disinfecting solutions”; 

(1>)—It shall be embalmed by an embalmer, licensed under the au¬ 
thority of the State, in accordance with a method accepted as complete 
and efficient by professional embalmers; 

(c) —After having been shrouded, or without shrouding, the body 
shall be enveloped in at least two thicknesses of cotton batting, heavy 
sheeting, cotton flannel, or blanket material, saturated with one of the 
“disinfecting solutions”; 

(d) —The body shall then be placed in a coffin susceptible of being 
hermetically sealed, provided such coffin can be obtained, and this in a 
case likewise susceptible of being hermetically sealed, both of which shall 
be so sealed; 

(e) —In the absence of a coffin susceptible of being hermetically 
sealed the space betwixt the coffin and the case must be compactly filled 
with dry saw-dust, excelsior, cotton, cotton-seed, sand, or pulverized 
charcoal, the material used being freely sprinkled, as laid in, with one of 
the “disinfecting solutions”; 

(f) —When a coffin is used not susceptible of being hermetically 
sealed the case in which it is placed must be susceptible of being hermet- 
icallv sealed, and must be so sealed; 

(g) —The case must not be carried into the infected part of the 
house, but the coffin, with the body therein, must be removed from the 
infected part of the house before being placed in the case; 

(h) —The body of a person who dies of yellow fever shall not be 
accepted by a public carrier for transportation except during the months 
of December, January, and February; nor the body of a person who dies 
of smallpox except during the months of June, July, August, and 
September. 

(i) —A certificate (Form No. 2) in triplicate must be furnished 
by the embalmer who prepares the body, and the original certificate, to¬ 
gether with the first and second copies thereof, must be applied and filed 
as provided for in specification (j) under Rule 1. 

RULE 3. 

The body of a person who dies of anthrax, bubonic plague, glanders, 
typhus fever, or cholera shall not be accepted by a public carrier for 
transportation, except on a special permit granted by the State 
Health Officer and that after the consent of the local health authorities 
of the place from which, and of the place to which, the body is to be trans¬ 
ported. In such a case special certificates showing the facts and giving 







4 


authority for the transportation of the body must be furnished and ap¬ 
plied and filed as provided for in specification (j) under Rule 1. 

♦ RULE 4. 

The body of a person who dies of a disease other than those diseases 
mentioned under Rules 1, 2, and 3 shall be entitled to transportation by 
a public carrier without further preparation than such as is usually em¬ 
ployed in advance of interment, provided that if offered for shipment 
between the first day of April and the first day of November it can reach 
its destination in twenty-four (24) hours, or less, from the time of death; 
at any other season the time shall be extended to thirty-six (36) hours. 

(a) —A certificate must be filled out in triplicate in accordance with 
form No. 1 or 2, according to whether the certificate is to be signed by a 
physician, or an embalmer, the original and the copies being applied and 
filed as provided for in specification (j) of Rule 1. Said certificate and 
the copies thereof shall be signed by the physician who attended the de¬ 
ceased person, or by the health officer having jurisdiction at the initial 
point of shipment, or by a reputable embalmer or undertaker. 

(b) —If the body of a person coming under this rule has been em¬ 
balmed bv an embalmer, licensed under the authority of the state, in 
accordance with a method accepted as complete and efficient by profes¬ 
sional embalmers, and if a certificate corresponding with Form No. 2, 
given below, be filled out in triplicate and applied and filed as provided 
for in specification (j) of Rule 1, then, no limitation as to time and sea¬ 
son shall apply. 


RULE 5. 

The body of a person who dies suddenly—by accident, suicide, 
homicide, or by any non-contagious or non-infectious disease—may be 
transported by a public carrier to such place as may be necessary or de¬ 
sirable, in order that it may receive proper care, without any preparation 
whatever, provided that putrefaction has not progressed to such extent 
as to obviously forbid such transportation. 

RULE 6. 

Nothing in these rules shall be so construed as to prevent the trans¬ 
portation of the bodies of deceased persons by private conveyance, or by 
public hearses, within the counties of the State, or to prevent the trans¬ 
portation of such bodies from one county to another by said conveyances, 
in order to reach cemeteries in which they are entitled to interment. 

A similar privilege shall apply to the bodies of deceased persons 
brought from points in adjoining states, near the line of this state, by 
said conveyances. 


RULE 7. 

The bodies of deceased persons brought into this state by public car¬ 
riers shall have been prepared by methods calculated to render them at 
least as safe as they would have been rendered by corresponding methods 
prescribed for the preparation of similar bodies in this state, and shall be 




5 


accompanied by satisfactory certificates showing that fact; provided that 
the body of a person who dies of yellow fever shall not be brought into the 
State except during the months of December, January, and February, 
nor the body of a person who dies of smallpox except during the months 
of June, July, August, and September; and provided further that the 
bodies of persons who die of anthrax, bubonic plague, cholera, or typhus 
fever shall not be brought into the State, except on a special permit 
granted by the State Health Officer. 

RULE 8. 

It shall not be lawful for a public carrier to bring into this state, or 
to accept for transportation in this state, the body of a deceased person 
in which decomposition has progressed to such extent as to render said 
body seriously objectionable, even though such body be accompanied by 
the prescribed certificates. 

Should difference of opinion as to the fitness of the body of a deceas¬ 
ed person for transportation arise betwixt a public carrier and the per¬ 
son in charge of the body, the latter may appeal to any legal health offi¬ 
cer in the vicinity, whose decision in the premises shall be accepted. 

RULE 9. 

When the bodies of deceased persons are offered for shipment pub¬ 
lic carriers shall furnish all reasonable facilities for the prompt and 
expeditious transportation thereof. 

RULE 10. 

The health authorities of the locality from which the body of a de¬ 
ceased person who dies of a contagious or infectious disease is shipped 
by a public carrier shall decide as to who may accompany the body, and 
as to the precautions which such persons shall observe in order to pre¬ 
vent them from becoming carriers of infection. When the prescribed pre¬ 
cautions have been complied with said authorities shall furnish such per¬ 
sons with written permits to accompany the body. 


ii. Exhumation of the bodies of deceased persons, or the removal 

OF SUCH BODIES FROM VAULTS. 

RULE 11. 

The body of a person who dies of a disease other than anthrax, 
bubonic plague, glanders, typhus fever, or cholera may be accepted by a 
public carrier for transportation after exhumation, or after removal from 
a vault, provided that the following requirements be complied with: 

(a)—Twelve months must have elapsed betwixt interment, or plac¬ 
ing in vault, and disinterment, or removal from vault, unless such body 
was shortly after death embalmed by an embalmer, licensed under 
authority of the State, in accordance with a method accepted as complete 
and efficient by professional embalmers, and unless that fact be estab¬ 
lished by a certificate signed by the embalmer who did the work, in which 
case the above limitation as to time shall not apply; 



(b) —During the progress of the exhumation the soil overlying and 
surrounding the body must be freely sprinkled with one of the “disin¬ 
fecting solutions”; 

(c) —The coffin, if in a state of sufficient preservation, shall be en¬ 
veloped in at least two thicknesses of blanket material, cotton flannel, 
or batting, or heavy sheeting, saturated with one of the “disinfecting so¬ 
lutions” and then placed in a new zinc-, tin-, or copper-lined case, which 
must be hermetically sealed and not reopened. If the coffin is not in a 
good state of preservation, the remains shall be transferred to another 
coffin susceptible of being hermetically sealed, and it shall be so sealed, 
and this placed in a new case, likewise susceptible of being hermetically 
sealed, and it shall be so sealed. 

If odors so require, the coffin must be surrounded in the case by dry 
saw-dust, excelsior, cotton, cotton-seed, sand, or pulverized charcoal, 
freely sprinkled, as laid in, with one of the “disinfecting solutions.” A roll 
of absorbent cotton, or a sponge, of suitable size, or a closely rolled sheet, 
upon which not less than six (6) ounces of formaldehyde, or carbolic 
acid, have been poured must likewise be placed in the case, after which 
the case must be hermetically sealed and not again opened; 

(d) —A certificate, in triplicate, (Form No. 3), shall be signed 
by the health officer who has jurisdiction over the locality at which the 
disinterment, or removal from vault, takes place, or by an embalmer li¬ 
censed under the authority of the State, and the original certificate and 
the copies thereof shall be applied and filed as prescribed in specification 
(j) under Kule 1; 

(e) —In the removal of a body from a vault the same limitations 
as to diseases, time of removal, condition of coffin, and substitution of a 
new case, susceptible of being hermetically sealed, for the one in which 
the coffin was originally placed, that were prescribed for the exhumation 
of a body shall apply; 

(f) —Before the disinterment of a body, or the removal of one from 
a vault, for transportation by a public carrier is undertaken, a written 
permit from the local health authorities of the place from which, and of 
the place to which, the body is to be removed must be obtained; 

(g) —The written permit granted by the health authorities of the 
place from which the body is to be removed must be permanently filed by 
the undertaker, or person, employed to disinter the body, or to remove it 
from a vault; the written permit of the health authorities of the place at 
which the body is to be re-interred, or placed in a vault, must be perma¬ 
nently filed by the undertaker, or person, employed to take charge of the 
bodv. 

RULE 12. 

The body of a person who dies of yellow fever shall not be disin¬ 
terred, or removed from a vault, for the purpose of being transported by 
a public carrier, except during the months of December, January, and 
February; nor the body of a person who dies of smallpox, except during 
the months of June, July, August, and September. 





DISINFECTING SOLUTIONS. 


Formula No. 1. 


Corrosive sublimate_Half a drachm 

Muriate of ammonia (Sal Ammoniac)_Two drachms 

Water — -Two quarts 


or 


Corrosive sublimate_ _Four tablets 

Water__Two quarts 


Mix in an earthen, wooden , or glass vessel, and after using cleanse the 
vessel very thoroughly, as the mixture would he poisonous if any of it were 
taken internally hy mistake. Persons with abrasions, cuts, or sores on their 
hands should not immerse them in the solution. 


Formula No. 2. 


Carbolic acicl (pure)_Four ounces 

Water_Two quarts 


Mix in an earthen , wooden, or glass vessel, and after using cleanse the 
vessel very thoroughly. 


Formula No. 3. 


Formaldehyde __ _One pint 

Water __ _Three pints 


Mix and observe the same precautions as prescribed above. 











f. 


8 

FORMS. 

Form 1. ORIGINAL CERTIFICATE. 

(To be securely tacked (not pasted)on lid of case containing body.) 

I certify that___ 

male (female) ; white (colored) ; aged_years (months) ; whose body 

is contained herein died of___ 

on the_day of_, 191_, at- 

o’clock, A. M. (P. M.) ; and I further certify that said body has been prepared 
in strict accordance with Rule_of a set of rules regulating the trans¬ 

portation of the bodies of deceased persons in this state by public carriers, 
and is therefore entitled to transportation in accordance with the provisions 
of said Rule. 


Place_ __ M. D. 

Date_ 

Form 1. FIRST COPY. 


(To be filed with public carrier at initial point of shipment.) 

I certify that_____ 

male (female) ; white (colored) ; aged_years (months) ; whose body 

is contained herein died of___ 

on the_day of_, 191_, at_ 

o’clock, A. M. (P. M.) ; and I further certify that said body has been prepared 
in strict accordance with Rule_of a set of rules regulating the trans¬ 

portation of the bodies of deceased persons in this state by public carriers, 
and is therefore entitled to transportation in accordance with the provisions 
of said Rule. 


Place_ __ M. D. 

Date_ 

Form 1. SECOND COPY. 


(To be tiled with public carrier at terminal point of shipment.) 

I certify that___ 

male (female) ; white (colored) ; aged_years (months) ; whose body 

is contained herein died of___ 

on the_day of_, 191_, at_ 

o’clock, A. M. (P. M.) ; and I further certify that said body has been prepared 
in strict accordance with Rule_of a set of rules regulating the trans¬ 

portation of the bodies of deceased persons in this state by public carriers, 
and is therefore entitled to transportation in accordance with the provisions 
of said Rule. 

Place_ _ M. D. 

Date_ 


COUPON. 


I certify that the body of. 
shipped from_ 


__(its destination), at__ 

A. M. (P. M.), and further, that said body appeared to be in 
condition. 


, reached 
_ o’clock, 


Date_ ___ 

Baggage Master. 
Expressman. 

Note : The Baggage Master, or Expressman, at terminal point should fill out this Cou¬ 
pon—stating whether the body is in good, fair, or bad condition—detach it, and mail to the 
party who signed the certificate. 







































9 


Form 2. ORIGINAL CERTIFICATE. 

(To be securely tacked (not pasted) on lid of case containing body.) 

I certify that-, male (female) ; white_ 

(colored) ; aged-years (months) ; whose body is contained herein 

died of-, on the_day of_ 

191-, at-o’clock A. M. (P. M.) ; and I further certify that said 

body has been embalmed in accordance with a method deemed complete and 
efficient by professional embalmers, and is therefore entitled to transporta¬ 
tion by public carriers under Rule_ 

I am a licensed Embalmer under the authority of the State, the No. of my 
certificate being_ 

Place- - 

Date _ Embalmer. 


Form 2. FIRST COPY. 

(To be filed with agent of public carrier at initial point.) 

I certify that_, male (female) ; white_ 

(colored) ; aged_years (months) ; whose body is contained herein 

died of_, on the_day of_ 

191_, at_o’clock A. M. (P. M.) ; and I further certify that said 

body has been embalmed in accordance with a method deemed complete and 
efficient by professional embalmers, and is therefore entitled to transporta¬ 
tion by public carriers under Rule_ 

I am a licensed Embalmer under the authority of the State, the No. of my 
certificate being_ 

Place- - 

Date __ _ __ Embalmer. 


Form 2. SECOND COPY. 

(To be filed with agent of public carrier at terminal point.) 

I certify that_, male (female) ; white_ 

(colored) ; aged_years (months) ; whose body is contained herein 

died of_, on the_day of_ 

191_, at_o’clock A. M. (P. M.) ; and I further certify that said 

body has been embalmed in accordance with a method deemed complete and 
efficient by professional embalmers, and is therefore entitled to transporta¬ 
tion by public carriers under Rule_ 

I am a licensed Embalmer under the authority of the State, the No. of my 
certificate being_ 

Place- - 

Embalmer. 


COUPON. 


I certify that the body of 


shipped from_, reached- 

(its destination, at_o’clock, A. M. (P. M.); and further that said body 

appeared to be in-condition. 

-Q a ^ e _ _ - Baggage Master. 

Expressman. 


'Note: The Baggage Master, or Expressman, at terminal point should till out this Cou¬ 
pon—stating whether the body is in good, fair, or bad condition—detach it, and mail to the 
party who signed the certificate. 










































10 


Form 3. ORIGINAL CERTIFICATE. 

(To be securely tacked (not pasted ) on lid of case containing body.) 

I certify that the body of___ 

male (female) ; white (colored) ; aged_years (months) ; who died of 

_on the_day of_, 

191_, at_ was disinterred 

(or removed from vault) in strict accordance with Rule ELEVEN of a set of 
rules regulating the transportation of the bodies of deceased persons in this 
State, and is therefore entitled to transportation by public carriers under 
said Rule. M n 

Place_ 

Date-191- Health Officer of _ 

Embalmer. 

Form 3. FIRST COPY. 

(To be filed with public carrier at initial point of shipment.) 

I certify that the body of___ 

male (female) ; white (colored) ; aged_years (months) ; who died of 

_on the_day of_, 

191_, at _ was disinterred 

(or removed from vault) in strict accordance with Rule ELEVEN of a set of 
rules regulating the transportation of the bodies of deceased persons in this 
State, and is therefore entitled to transportation by public carriers under 
said Rule. ^ jj 


Place_ 

Date_191_ 


Health Officer of 


Embalmer. 


Form 3. SECOND COPY. 

(To be filed with public carrier at terminal point of shipment.) 

I certify that the bodv of___ 

male (female) ; white (colored) ; aged_years (months) ; who died of 

-on the_Lday of__ 

191_, at __ was disinterred 

(or removed from vault) in strict accordance with Rule ELEVEN of a set of 
rules regulating the transportation of the bodies of deceased persons in this 
State, and is therefore entitled to transportation by public carriers under 
said Rule. ^ ^ 


Place_ 

Date_191__. 


Health Officer of 


Embalmer. 


COUPON. 

I certify that the body of_, shipped 

from_, reached_ 

(its destination), at_o’clock A. M. (P. M.), and further that said 

body appeared to be in_condition. 

Date_191_ _ 

Baggage Master. 

Expressman. 

Note: When above Certificates arc filled out, and signed by a health officer the word 

“Embalmer” should be marked out; when filled out and signed by an embalmer the words 
“Health Ofgcer of” should be marked out; so of the words Baggage Master and Expressman. 







































11 


DISINTERMENT, OR REMOVAL FROM VAULT, AFTER THE LAPSE 

OF TWELVE MONTHS. 


When a body is to be disinterred, or removed from a vault, for transpor¬ 
tation by a public carrier after the lapse of twelve months from the time of 
death, the following certificate (in duplicate) must, in addition to other cer¬ 
tificates already provided for, be filled out by the health officer, or embalmer, 
who superintends the disinterment, or the removal from vault. 

The original Certificate must be delivered to, and filed by, the health au¬ 
thorities of the place at which the body is to be disinterred, or removed from 
vault, and the duplicate must be delivered to, and filed by, the health authori¬ 
ties of the place at which the body is to be re-interred. 


ORIGINAL CERTIFICATE. 

Form 4. 

I certify that the remains herein contained are those of 


who died of___ 

and that twelve months elapsed betwixt the interment and disinterment of 
the bodv. 

•j 

I further certify that in the disinterment of said remains the method 
prescribed under Rule —, of a set of rules for regulating the disinterment 
and transportation of bodies, issued by the State Board of Health, was 
strictly complied with. 


Place- -- M. D. 

Date-191- Health Officer of _ 

Embalmer. 


Form 4. 


DUPLICATE CERTIFICATE. 


I certifv that the remains herein contained are those of 
•/ 


who died of___ 

and that twelve months elapsed betwixt the interment and disinterment of 

the body. 

1 further certifv that in the disinterment of said remains the method 
prescribed under Rule —, of a set of rules for regulating the disinterment 
and transportation of bodies, issued by the State Board of Health, was 
strictly complied with. 


Place- -- M. D. 

Date-191- Health Officer of _ 

Embalmer. 


Note: When above certificates are signed by a health officer the word “ Embalmer ” 
should be marked out , and vice versa. 
















12 


DISINTERMENT OR REMOVAL FROM VAULT IN LESS THA 

TWELVE MONTHS. 


When a body is to be disinterred, or removed from a vault, for transpc 
tation by a public carrier in less than twelve months from the time of deaf 
the following certificate (in duplicate) must, in addition to other certificat 
already provided for, be filled out by the embalmer who embalmed the boc 
just after death. 

The Original Certificate must be delivered to, and filed by, the health a 
thorities of the place at which the body is to be disinterred, and on which 
permit for disinterment is granted; the duplicate must be delivered to, ai 
filed by, the health authorities of the place at which the body is to be rei 
terred, upon which a permit for reinterment is granted. 

EMBALMERS CERTIFICATE. 

Form 5. ORIGINAL. 

I certify that on the_day of_, 191 

within_hours after the death of _ 

male (female) ; white (colored) ; aged_years (months), who died < 

__ _,1 embalmed the body of the sai 

___in accordance with a method accepte 

as complete and efficient by professional embalmers. 

I am licensed under authority of the State as an embalmer, my certifica 
being numbered_ 

Place_ _ 

Date_191_ Embalm < 

EMBALMERS CERTIFICATE. 

Form 5. DUPLICATE. 

I certify that on the_day of_, 191 

within_hours after the death of_ 

male (female) ; white (colored) ; aged_years (months), who died < 

___I embalmed the body of the sai 

___in accordance with a method accepte 

as complete and efficient by professional embalmers. 

I am licensed under authority of the State as an embalmer, my certificat 
being numbered_ 

Place_ _ 

Date_191_ Embalmet 

Note : Should a physician, health officer, or embalmer not be supplied with printed blan 
certificates, when needed, the proper form can be copied with type machine, or pen, and use< 





















































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